Beruflich Dokumente
Kultur Dokumente
Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents
Originating Council
Council on Clinical Affairs
Review Council
Council on Clinical Affairs
Adopted
2002
Revised
2006, 2010
Purpose The American Academy of Pediatric Dentistry (AAPD) recognizes that caries-risk assessment and management protocols can assist clinicians with decisions regarding treatment based upon caries risk and patient compliance and are essential elements of contemporary clinical care for infants, children, and adolescents. This guideline is intended to educate healthcare providers and other interested parties on the assessment of caries risk in contemporary pediatric dentistry and aid in clinical decision making regarding diagnostic, fluoride, dietary, and restorative protocols. Methods This guideline is an update of AAPDs Policy on Use of a Caries-risk Assessment Tool (CAT) for Infants, Children, and Adolescents, Revised 2006 that includes the additional concepts of dental caries management protocols. The update used electronic and hand searches of English written articles in the medical and dental literature within the last 10 years using the search terms caries risk assessment, caries management, and caries clinical protocols. From this search, 1,909 articles were evaluated by title or by abstract. Information from 75 articles was used to update this document. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experienced researchers and clinicians. Background Caries-risk assessment Risk assessment procedures used in medical practice normally have sufficient data to accurately 1 quantitate a persons disease susceptibility and allow for preventive measures. Even though caries-risk data in dentistry still are not sufficient to quantitate the models, the process of determining risk should be 2 a component in the clinical decision making process. Risk assessment: 1. fosters the treatment of the disease process instead of treating the outcome of the disease; 2. gives an understanding of the disease factors for a specific patient and aids in individualizing preventive discussions; 3. individualizes, selects, and determines frequency of preventive and restorative treatment for a patient; and 4. anticipates caries progression or stabilization. Caries-risk assessment models currently involve a combination of factors including diet, fluoride exposure, a susceptible host, and microflora that interplay with a variety of social, cultural, and behavioral 3-6 factors. Caries risk assessment is the determination of the likelihood of the incidence of caries (ie, the 7 number of new cavitated or incipient lesions) during a certain time period or the likelihood that there will be a change in the size or activity of lesions already present. With the ability to detect caries in its earliest 8-10 stages (ie, white spot lesions), health care providers can help prevent cavitation.
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Factors
Biological Mother/primary caregiver has active cavities Parent/caregiver has low socioeconomic status Child has >3 between meal sugar-containing snacks or beverages per day Child is put to bed with a bottle containing natural or added sugar Child has special health care needs Child is a recent immigrant Protective Child receives optimally-fluoridated drinking water or fluoride supplements Child has teeth brushed daily with fluoridated toothpaste Child receives topical fluoride from health professional Child has dental home/regular dental care Clinical Findings Child has white spot lesions or enamel defects Child has visible cavities or fillings Child has plaque on teeth
High Risk
Moderate Risk
Protective
Deleted:
Yes Yes Yes Yes
Circling those conditions that apply to a specific patient helps the health care worker and parent understand the factors that contribute to or protect from caries. Risk assessment categorization of low, moderate, or high is based on preponderance of factors for the individual. However, clinical judgment may justify the use of one factor (eg, frequent exposure to sugar containing snacks or beverages, visible cavities) in determining overall risk.
High
Moderate
Low
Factors
Biological Mother/primary caregiver has active caries Parent/caregiver has low socioeconomic status Child has >3 between meal sugar-containing snacks or beverages per day Child is put to bed with a bottle containing natural or added sugar Child has special health care needs Child is a recent immigrant Protective Child receives optimally-fluoridated drinking water or fluoride supplements Child has teeth brushed daily with fluoridated toothpaste Child receives topical fluoride from health professional Child has dental home/regular dental care Clinical Findings Child has >1 decayed/missing/filled surfaces (dmfs) Child has active white spot lesions or enamel defects Child has elevated mutans streptococci levels Child has plaque on teeth
High Risk
Moderate Risk
Protective
Circling those conditions that apply to a specific patient helps the practitioner and parent understand the factors that contribute to or protect from caries. Risk assessment categorization of low, moderate, or high is based on preponderance of factors for the individual. However, clinical judgment may justify the use of one factor (eg, frequent exposure to sugar-containing snacks or beverages, more than one dmfs) in determining overall risk.
High
Moderate
Low
Moderate Risk
Protective
Yes Yes
Yes Yes
Circling those conditions that apply to a specific patient helps the practitioner and patient/parent understand the factors that contribute to or
High
Moderate
Low
Risk Category
Diagnostics
Restorative Diet
Counseling Surveillance
Twice daily brushing with fluoridated toothpaste Fluoride supplements Professional topical treatment every 6 months
Counseling
Twice daily brushing with fluoridated toothpaste Professional topical treatment every 6 months
Twice daily brushing with fluoridated toothpaste Fluoride supplements Professional topical treatment every 3 months
Counseling
Active surveillance of incipient lesions Restore cavitated lesions with ITR or definitive restorations
Risk Category
Diagnostics
Diet
No
Sealants
Yes
Restorative
Surveillance
Twice daily brushing with fluoridated toothpaste Professional topical treatment every 6 months Brushing with 0.5% fluoride (with caution) Fluoride supplements Professional topical treatment every 3 months Brushing with 0.5% fluoride (with caution) Professional topical treatment every 3 months
Yes
Counseling
Yes
Yes
Risk Category
Diagnostics
Diet
No
Sealants
Yes
Restorative
Surveillance
Legends for Tables 4-6 Salivary mutans streptococci bacterial levels. Parental supervision of a smear amount of tooth paste.